PTSD symptoms, life events, and unit cohesion in U.S. soldiers: Baseline findings from the Neurocognition Deployment Health Study
Boston University, Boston, Massachusetts, United StatesJournal of Traumatic Stress (Impact Factor: 2.72). 08/2007; 20(4):495-503. DOI: 10.1002/jts.20234
Relationships among a modifiable situational factor (unit cohesion), prior stressful life events, and posttraumatic stress disorder (PTSD) symptoms were assessed in 1,579 U.S. Army soldiers with no history of contemporary war zone deployment. It was predicted that unit cohesion would attenuate the dose-response relationship between past stressor exposures and PTSD symptoms at relatively moderate levels of exposure. Consistent with this hypothesis, regression analysis revealed that life experiences and unit cohesion strongly and independently predicted PTSD symptoms, and that unit cohesion attenuated the impact of life experiences on PTSD. Some military personnel reported significant predeployment, stress-related symptoms. These symptoms may serve as vulnerabilities that could potentially be activated by subsequent war-zone deployment. Higher predeployment unit cohesion levels appear to ameliorate such symptoms, potentially lessening future vulnerability.
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- "The estimated prevalence of post-traumatic stress disorder (PTSD) in veterans deployed to Afghanistan and Iraq since 2000 has ranged from 2 to 26% (Hoge et al. 2006; Hotopf et al. 2006; Smith et al. 2008b; Thomas et al. 2010; Davy et al. 2012; Dobson et al. 2012; Kok et al. 2012; Elbogen et al. 2014). While a number of studies have shown that events over the life cycle (including adversity in childhood and deployment stressors), are associated with increased rates of PTSD (Brailey et al. 2007; Phillips et al. 2010; Horesh et al. 2011; Jones et al. 2013), fewer studies have focused on the underlying events associated with PTSD diagnoses or the time taken for PTSD symptoms to appear and subside after traumatic events. A greater understanding of the time-course of PTSD may help to identify those at risk and the number of individuals likely to present with PTSD symptoms at different times after exposure to traumatic events. "
ABSTRACT: Understanding the time-course of post-traumatic stress disorder (PTSD), and the underlying events, may help to identify those most at risk, and anticipate the number of individuals likely to be diagnosed after exposure to traumatic events. Data from two health surveys were combined to create a cohort of 1119 Australian military personnel who deployed to the Middle East between 2000 and 2009. Changes in PTSD Checklist Civilian Version (PCL-C) scores and the reporting of stressful events between the two self-reported surveys were assessed. Logistic regression was used to examine the association between the number of stressful events reported and PTSD symptoms, and assess whether those who reported new stressful events between the two surveys, were also more likely to report older events. We also assessed, using linear regression, whether higher scores on the Kessler Psychological Distress Scale or the Alcohol Use Disorder Identification Test were associated with subsequent increases in the PCL-C in those who had experienced a stressful event, but who initially had few PTSD symptoms. Overall, the mean PCL-C scores in the two surveys were similar, and 78% of responders stayed in the same PCL-C category. Only a small percentage moved from having few symptoms of PTSD (PCL-C < 30) in Survey 1 to meeting the criteria for PTSD (PCL-C ≥ 50) at Survey 2 (1% of all responders, 16% of those with PCL-C ≥ 50 at Survey 2). Personnel who reported more stressful lifetime events were more likely to score higher on the PCL-C. Only 51% reported the same stressful event on both surveys. People who reported events occurring between the two surveys were more likely to record events from before the first survey which they had not previously mentioned (OR 1.48, 95% CI (1.17, 1.88), p < 0.001), than those who did not. In people who initially had few PTSD symptoms, a higher level of psychological distress, was significantly associated with higher PCL-C scores a few years later. The reporting of stressful events varied over time indicating that while the impact of some stressors endure, others may increase or decline in importance. When screening for PTSD, it is important to consider both traumatic experiences on deployment and other stressful life events, as well as other mental health problems among military personnel, even if individuals do not exhibit symptoms of PTSD on an initial assessment.
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- "Similar findings have been found in other larger studies, which also had the advantage of having analyses adjusted for possible confounders (Rona, Hooper, et al., 2009; Sundin, Fear, Hull, et al., 2010). It has been proposed that this may be because unit cohesion is associated with individual resilience and adaptive coping with traumatic experiences (Brailey, Vasterling, Proctor, Constans, & Friedman, 2007; Whealin et al., 2007). It is difficult to fully unravel the direction of cause and effect between cohesion/leadership and mental health however, since those already suffering from mental health difficulties are more likely to be self-isolative or have a negative view of events and people around them, and thus to report worse cohesion and poorer leadership. "
ABSTRACT: A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.
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- "For example, women report lower perceived unit support or cohesion both prior to and during deployment than their male peers (Carter- Visscher et al, 2010; Vogt et al., 2005). Unit cohesion has been associated with lower odds of developing PTSD (Iversen et al., 2008) and has been shown to attenuate the association between prior stressors and PTSD (Brailey et al., 2007). Women also report lower perceptions of preparedness for deployment than men (Carter-Visscher et al, 2010), which has been shown to predict new onset of PTSD symptoms (Polusny et al., 2011). "
ABSTRACT: Although women in the military are exposed to combat and its aftermath, little is known about whether combat as well as pre-deployment risk/protective factors differentially predict post-deployment PTSD symptoms among women compared to men. The current study assesses the influence of combat-related stressors and pre-deployment risk/protective factors on women's risk of developing PTSD symptoms following deployment relative to men's risk. Participants were 801 US National Guard Soldiers (712 men, 89 women) deployed to Iraq or Afghanistan who completed measures of potential risk/protective factors and PTSD symptoms one month before deployment (Time 1) and measures of deployment-related stressors and PTSD symptoms about 2-3 months after returning from deployment (Time 2). Men reported greater exposure to combat situations than women, while women reported greater sexual stressors during deployment than men. Exposure to the aftermath of combat (e.g., witnessing injured/dying people) did not differ by gender. At Time 2, women reported more severe PTSD symptoms and higher rates of probable PTSD than did men. Gender remained a predictor of higher PTSD symptoms after accounting for pre-deployment symptoms, prior interpersonal victimization, and combat related stressors. Gender moderated the association between several risk factors (combat-related stressors, prior interpersonal victimization, lack of unit support and pre-deployment concerns about life/family disruptions) and post-deployment PTSD symptoms. Elevated PTSD symptoms among female service members were not explained simply by gender differences in pre-deployment or deployment-related risk factors. Combat related stressors, prior interpersonal victimization, and pre-deployment concerns about life and family disruptions during deployment were differentially associated with greater post-deployment PTSD symptoms for women than men.